2019 Volume 61 Issue 10 Pages 2337-2345
Background: There have been several studies on risk factors for lymph node metastasis in patients with submucosal invasive colorectal cancer, and the indication of additional surgical operation after endoscopic resection is controversial. Some case reports showed that the prognosis of submucosal invasive colorectal cancer may be worsened by initial endoscopic resection prior to subsequent surgical operation.
Methods: A total of 118 patients with submucosal invasive colorectal cancer who underwent colectomy with lymphadenectomy at our hospital, were analyzed. We investigated the risk factors for lymph node metastasis, and relapse-free and overall survival. We evaluated the influence of endoscopic resection of submucosal invasive colorectal cancer prior to surgical operation.
Results: Thirty-seven (31.4%) of the 118 patients underwent endoscopic resection prior to colectomy with lymphadenectomy. Lymphatic invasion was the only risk factor for lymph node metastasis. When lymphatic invasion was negative and depth of submucosal invasion was less than 3,500μm, there was no lymph node metastasis. There were no significant differences between the two groups who did or did not undergo endoscopic resection prior to surgical operation in relapse-free and overall survival.
Conclusion: Endoscopic resection of submucosal invasive colorectal cancer prior to surgical operation may not worsen the prognosis. Endoscopic resection with R0 resection prior to surgery may be applicable to submucosal invasive colorectal cancers when precise evaluation of depth of submucosal invasion is difficult.
